Análisis del impacto presupuestal en Colombia de la prueba de HPV con genotipificación comparada con la citología

Introduction:

The detection of the human papillomavirus (HPV) through the combination of the HPV test and other techniques such as cytology has impacted the detection and timely treatment of lesions associated with cervical cancer.

Objective:

To estimate the budgetary impact of the strategy of early detection of HPV with DNA test genotyping with reflex cytology versus conventional cytology in women aged 30 to 65 years attending the cervical cancer screening program at a health benefit managing entity in Colombia.

Materials and methods:

Using a decision tree and a Markov model, the clinical implications and direct costs of screening, diagnosis, and treatment were estimated in a cohort of women. The analysis considered two screening cycles and their annual costs. The data on the prevalence of clinical results and the costs were taken from the health managing entity. The information on the progression, persistence, and regression of the health states were taken from the ATHENA study.

Results:

The screening scheme with the HPV test, genotyping, and reflex cytology compared to conventional cytology was cost-saving. The average cost per screening cycle with the HPV test was estimated at COP $ 129,201,363 and with cytology at COP $ 186,309,952, i.e., a saving of COP $ 57,108,589 (30.7%).

Conclusion:

The implementation of the screening strategy under evaluation suggests prospective savings derived from the early detection of health states associated with the development of cervical cancer.     

Grupos de riesgo citogenético de leucemia mieloide aguda pediátrica a partir del análisis de supervivencia en un hospital de referencia para cáncer en Perú

Introduction:

Acute myeloid leukemia is a heterogeneous disorder characterized by immature myeloid cell proliferation. Cytogenetic analysis has revealed the presence of chromosomal aberrations important to patient prognosis.

Objective:

To determine cytogenetic risk groups of pediatric patients with acute myeloid leukemia according to overall survival.

Materials and methods:

In this cross-sectional observational study, the clinical records of pediatric patients diagnosed with de novo acute myeloid leukemia admitted to the Instituto Nacional de Enfermedades Neoplásicas between 2001 and 2011 with cytogenetic analysis of bone marrow were included. Cytogenetic risk groups were established according to the criteria of the Medical Research Council. Overall survival curves were generated with the Kaplan-Meier method and compared using the Mantel-Cox test and Cox regression with the software R, version 3.3.2.

Results:

A total of 130 patients were included, 68 males (52.3%) and 62 females (47.7%), most of them with subtype M2 (33%). The average age was 7.7 years (range: 0-15 years).Chromosomal aberrations were observed in 60.8% of the patients, the most frequent of which was the translocation t(8;21). According to the overall survival analysis, two cytogenetic risk groups were established: favorable and unfavorable.

Conclusion:

Two groups of cytogenetic risk were determined: high (or unfavorable) and standard (favorable).     

Manifestaciones mucocutáneas y su relación con el recuento de linfocitos T CD4 en pacientes infectados con el virus de inmunodeficiencia humana hospitalizados en Medellín,Colombia

Introduction.

About 80-95% of patients infected with the human immunodeficiency virus (HIV) develop skin manifestations, which are markers of the patients’ immune status. Objective. To describe the dermatologic manifestations and the clinical and sociodemographic factors of hospitalized patients diagnosed with HIV and their correlation with CD4 T-lymphocyte count.

Materials and methods.

We conducted an observational, cross-sectional, and retrospective study of the medical records of 227 adult patients with HIV diagnosis evaluated by dermatology in a hospital in Medellín, Colombia.

Results.

We included 227 patient records with 433 dermatologic manifestations, 64.4% of them infectious. The most frequent manifestations were oral candidiasis, condylomata acuminata, and drug reactions. Moreover, a statistically significant relationship was found between disseminated herpes zoster virus and secondary syphilis with a CD4 count between 200-499 cells/mm³ (p=0.04 and 0.028, respectively). There was also a statistically significant relationship between oral candidiasis and a CD4 count of less than 100 cells/ mm³ (p=0.008).

Conclusions.

The relationship between disseminated herpes zoster with CD4 between 200-499 cells/mm³ suggests that, despite having high CD4 counts, severe forms of the disease may occur due to possible T-cell dysfunction and depletion of the immune system. Additionally, the relationship between oral candidiasis and CD4 less than 100 cells/mm³ indicates the potential role of oral candidiasis as an essential marker of weakened immune status in HIV patients.     

Evaluación de la efectividad de la prueba rápida OptiMAL-IT™ para el seguimiento de pacientes con diagnóstico de malaria en la Amazonía peruana

Introduction:

In Peru, optical microscopy with the thick smear test continues to be performed for the follow-up of malaria patients. This test is simple but it requires microscopic equipment and suitable staff to perform the reading of the samples. Studies suggest that the rapid OptiMAL-IT™ test is an option for follow-up.

Objective:

To evaluate the effectiveness of OptiMAL-IT™ as a follow-up test in malaria patients in endemic areas of Perú.

Materials and methods:

We conducted an observational, analytical cross-sectional study of diagnostic tests performed in patients with malaria. We selected all the patients attending different health facilities in the Peruvian departments of San Martín and Loreto who met the inclusion criteria. Optical microscopy with thick smear and OptiMAL-IT™ was used on days 2, 3, 7, and 14 for Plasmodium vivax and until day 21 of follow-up for Plasmodium falciparum. Percentages of correctly classified samples and predictive values were calculated, and the results were compared between the western jungle and the eastern jungle using Chi2 or Fisher''s exact tests.

Results:

We registered 262 patients from San Martín and 302 from Loreto. The percentage of correctly classified cases and the negative predictive value were higher than 92.0% and 93,0%, respectively, from the third day of follow-up; no statistical differences were found in the results obtained from the western jungle and those from the eastern jungle.

Conclusions:

The OptiMAL-IT™ test would be effective as a follow-up test in patients diagnosed with malaria in endemic areas of Perú.     

Membrana de cáscara de huevo para la curación de heridas superficiales en ratones

Introduction:

Eggshell membranes offer beneficial properties for tissue regeneration and their biomedical applications are important.

Objective:

To demonstrate the effectiveness of hen unfertilized eggshell membranes in the treatment of superficial open wounds in mice compared to the conventional procedure.

Materials and methods:

15-mm linear wounds were made on the back of 10 male CF-1 mice. The mice were divided into four groups. One group did not receive any treatment and the other three were given conventional treatment, eggshell membranes dressing, and eggshell membranes powder. The evolution of the wounds was registered by photographs.We measured wounds length and healing time and calculated the length reduction rate and the percentage of healing. The healing percentages were analyzed by ANOVA with a post hoc Dunnett test (p<0.05).

Results:

The treatments with eggshell membranes and membrane powder had a wound- length reduction rate of 1.009 and 1.020 mm/day, greater than the conventional treatment, of 0.852 mm/day, and a healing time of 12 days, i.e., less than the 16-day conventional treatment. The statistical analysis showed significant differences between eggshell membrane treatments and the conventional treatment.

Conclusions:

Eggshell membrane dressing and eggshell membrane powder applied to open superficial wounds in mice were more effective than the conventional treatment in regenerating injured tissue in mice.     

Conflicto armado,contaminación y riesgos en salud: una evaluación de riesgo de tres fuentes de exposición ambiental asociadas con el conflicto en Colombia

Introduction:

Armed conflicts affect territories rich in resources and biodiversity. As a result of the environmental damage caused by violent actions, the health of populations can be affected.

Objectives:

To assess the risks to human health due to environmental degradation associated with three violent actions in the context of the Colombian armed conflict: Pipeline bombing, informal mining with mercury, and spraying of illicit crops with glyphosate.

Materials and methods:

We conducted a quantitative evaluation of the risks to individual health associated with armed conflict activities using methodologies focused on the routes of pollutants dispersion, their concentrations in the environment, the exposure of the individuals, and the risks of carcinogenic and non-carcinogenic effects.

Results:

The risk assessment of the armed conflict-related actions under study evidenced intolerable carcinogenic risk and unacceptable non-carcinogenic risk due to the consumption of water and fish contaminated by polycyclic aromatic hydrocarbons (PAH), mercury, and glyphosate.

Conclusions:

The study reiterates the inextricable connections existing among the environment, society, and health, as well as the implications of environmental violence for the public health of vulnerable population groups and, in general, for the well-being of all living beings affected by the armed conflict.     

Importancia de la determinación de variantes en el número de copias en neonatos con aneuploidías autosómicas

Introduction:

Aneuploidies are frequent genetic disorders in clinical practice. However, little is known about other genetic variants that may influence the final phenotype.

Objective:

To determine the variations in the number of copies and regions with homozygosity greater than 0.5% or larger than 10 Mb in newborns with autosomal aneuploidies.

Materials and methods:

We performed a chromosomal microarray analysis on newborns with autosomal aneuploidies (n=7), trisomy 21 (n=5), and trisomy 18 (n=2) evaluated at the Hospital Antonio Lorena and Hospital Regional of Cusco, Perú, during 2018.

Results:

We found pathogenic and probably pathogenic variants in the number of copies in other genomic regions different to chromosomes 21 or 18 in two neonates. Additionally, we found two variants bigger than 500 kpb of unknown pathogenicity.

Conclusions:

Although the number of analyzed individuals was small, it is important to highlight that we found other variants in the number of copies that have been described in association with neurodevelopmental disorders, congenital anomalies, deafness, and short/ tall stature, among others, in almost half of them, which will probably impact the phenotype negatively in patients with aneuploidies.     

Complicaciones hospitalarias en una unidad geriátrica de agudos

Introduction:

In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care.

Objective:

To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia

Materials and methods:

We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson’s linear regression model to identify associated variables.

Results:

The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications.

Conclusion:

In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.     

Factores asociados con la presencia de endoparásitos y ectoparásitos en perros domiciliados de la zona metropolitana de Toluca,México

Introduction:

Endoparasites and ectoparasites in dogs are of global distribution. The close relationship between dogs and man implies a risk for the transmission of zoonotic parasites. Therefore, it is necessary to determine the parasites hosted by dogs in specific areas and the factors associated with their presence.

Objectives:

To identify and to estimate the prevalence of endoparasites and ectoparasites in domiciled dogs in the Metropolitan area of Toluca, México, and the prevalence of D. caninum in fleas of the genus Ctenocephalides spp.

Materials and methods:

We collected samples from 402 domiciled dogs in four reference hospitals in the area in Toluca. We diagnosed endoparasites using direct smear, flotation, and sedimentation techniques and we performed the taxonomic identification of ectoparasites. Finally, the molecular diagnosis of D. caninum in fleas was made using the polymerase chain reaction technique (PCR).

Results:

A total of 37.2% of dogs were positive for endoparasites; the genera or species identified were Toxocara spp., Giardia spp., Ancylostoma spp., Cystoisospora spp., D. caninum, Taenia spp., and Trichuris vulpis; the prevalence of ectoparasites was 13.13%. We identified fleas of the species Ctenocephalides felis, Ctenocephalides canis; only one animal was parasitized with Rhipicephalus sanguineus and another one with Trichodectes canis; the prevalence of D. caninum in fleas was 9.5%.

Conclusion:

The prevalence of endoparasites was 37.2% while that of ectoparasites was 13.1%; this is the first analysis of endoparasites and ectoparasites conducted in the same population of dogs in México together with the molecular diagnosis of D. caninum in fleas.     

Niveles de micronutrientes en niños escolares colombianos e inseguridad alimentaria

Introduction:

Half of the Colombian households experience some degree of food insecurity. Food insecurity has been associated with malnutrition, which could result in micronutrient deficiencies in children; however, the evidence is not conclusive.

Objective:

To examine the associations between food insecurity and blood concentrations of hemoglobin, ferritin, vitamin A, vitamin B12, folate, and zinc in school-age children from Bogotá, Colombia.

Materials and methods:

We conducted a cross-sectional study among 2,660 children aged 5-12 from Bogotá''s public schools. We assessed their household food insecurity level with the Spanish version of the Household Food Security Survey Module (HFSSM), a validated scale, and quantified blood biomarkers of iron, vitamin A, folate, vitamin B12, and zinc status. We examined the associations between food insecurity, severe hunger, and micronutrient status biomarkers using propensity scores.

Results:

Three-quarters of households had some degree of food insecurity and 12 % had food insecurity and severe hunger. Prevalence of marginal vitamin B12 status and vitamin A and zinc deficiencies were, respectively, 17%, 14%, and 1.4%. Compared with children from households without severe hunger, those exposed to it had lower adjusted mean concentrations of vitamin A, vitamin B12, and folate, but these differences were not statistically significant.

Conclusion:

Food insecurity with severe hunger was not associated with micronutrient status biomarkers in Colombian school-age children. The HFSSM may adequately measure hardship in food acquisition due to lack of resources, but it does not yield an index that is associated with micronutrient status biomarkers.     

Malformaciones esqueléticas y alteraciones del crecimiento en fetos de ratas con diabetes moderada

Introduction:

Currently, diabetes mellitus represents one of the medical conditions that more frequently complicates pregnancy affecting the fetus''s growth and development.

Objective:

To determine the skeletal malformations and growth alterations in fetuses of diabetic Wistar rats.

Materials and methods:

We used a neonatally streptozotocin-induced mild diabetes model (STZ 100 mg/kg body weight - subcutaneously) in Wistar rats. In adulthood, healthy and diabetic rats were mated with healthy males of the same age and strain. On day 20 of gestation, a cesarean was performed under anesthesia. Fetuses were removed, weighed, and classified as small (SPA), adequate (APA), and large (LPA) for the gestational age. Selected fetuses were processed for skeletal anomaly and ossification sites analysis.

Results:

In the offspring of diabetic rats, there was a higher percentage of fetuses classified as small or large and a lower percentage of fetuses with adequate weight; the fetal weight mean was lower and there were fewer sites of ossification.Alterations were observed in the ossification of the skull, sternum, spine, ribs and fore and hind limbs; and also, there was a direct correlation between fetal weight and ossification degree There were congenital malformations associated with fusion and bifurcation of the ribs, as well as changes indicative of hydrocephaly, such as the dome shape of the skull, a wide distance between parietals, and the width of the anterior and posterior fontanels.

Conclusion:

Moderate diabetes during pregnancy alters fetal growth and development with macrosomia and intrauterine growth restriction, as well as skeletal malformations.     

Malaria importada en población pediátrica de Alicante,España (1994-2019)

Introduction:

In recent years there has been an increase in imported malaria among children in whom it is a potentially serious and fatal disease.

Objective:

To describe the incidence and the clinical and epidemiological characteristics of malaria in children diagnosed in Alicante, Spain, over a 26-year period.

Materials and methods:

We conducted an observational retrospective study of malaria in children aged under 15 years diagnosed at the Alicante General University Hospital from 1994 to 2019.

Results:

Twenty-four cases were registered over the study period. The frequency of cases increased from 2 over the first five years to 11 in the last five years. The median age of the children was 6 years (interquartile range: 3-8); 91.6% came from sub-Saharan Africa. Over half (n=15, 62.5%) were children born in Spain to immigrant parents visiting friends and relatives (VFR); just one (6.7%) had received antimalarial chemoprophylaxis.The most frequent clinical signs were fever (86.9%), hepatosplenomegaly (70.8%), and anemia (70.8%). Plasmodium falciparum was the most frequently identified species (83.3%, n=20). The most common treatment was oral piperaquine/dihydroartemisinin (41.6%, n=10) with favorable outcomes in all cases.

Conclusions:

Imported childhood malaria shows an increasing incidence and a nonspecific clinical presentation. Professional awareness of this disease and a high degree of clinical suspicion are needed for the early initiation of treatment. Pre-travel preventive measures should be promoted when appropriate.     

COVID-19 y salas de análisis del riesgo en salud pública en cuatro departamentos fronterizos de Colombia

Introduction:

Public health risk management in Colombia is led by the Instituto Nacional de Salud. In the face of the COVID-19 emergency, response actions centered on the implementation of risk analysis rooms and the strengthening of surveillance at points of entry into the country.

Objective:

To analyze the implementation and maintenance phases of the COVID-19 risk analysis rooms in four border departments of Colombia.

Materials and methods:

We conducted a qualitative study of public health risk analysis rooms for COVID-19. We reviewed the documentation and data generated from March to June, 2020, in the departments of Amazonas, Vichada, Guainía, and Putumayo. We did semi-structured interviews with key actors and analyzed the answers using the NVivo plus version 11 application in three cycles: open coding, identification of emerging categories, and modeling by analyzing the identified strengths and weaknesses.

Results:

We identified the components of the incident command structure and the relationships between the public health areas. Strengths were evidenced in the integration of the areas: the management of information in real time, the border surveillance and the capabilities of rapid response teams, while weaknesses appeared in planning, community surveillance, and risk communication processes.

Conclusions:

Risk analysis rooms constitute a joint effort at the national and local levels which has promoted the articulated participation of all actors in the analysis of information and the optimization of an organized response during the COVID-19 pandemic.     

Prevalencia de eventos adversos y sus manifestaciones en profesionales de la salud como segundas víctimas

Introduction:

Adverse events can cause harm to the patient, but they also affect health professionals making them second victims of the event. Interventions have been focused mostly on patients, but little on professionals, probably due to lack of tools.

Objective:

To estimate the prevalence of adverse events and describe their manifestations in healthcare personnel to evidence the phenomenon of second victims in a highly complex hospital.

Materials and methods:

We conducted an analytical cross-sectional study by a survey of 419 healthcare professionals from the hospitalization, emergency, and surgical areas in a highly complex hospital in Medellín in 2019. The frequency of adverse events was estimated and its association with some labor and demographic variables was determined.

Results:

We found that 93.1% of the participants knew of incident cases and 79% of serious adverse events while 44.4% had been involved in them and 99% of these had feelings as a second victim, mainly the difficulty to concentrate, guilt, fatigue, anxiety, and doubts about decisions; 95% indicated they wanted to receive training to face the consequences of adverse events and know how to inform the patient.

Conclusions:

Health professionals are frequently exposed to adverse events that can cause negative emotions in them such as guilt, fatigue, anxiety, and insecurity. Most professionals who participate in an adverse event express feelings as a second victim. Informing the patient about an adverse event requires preparation and most professionals requested training on the subject.     

Detección molecular de Toxoplasma gondii en carnes para consumo humano en Ibagué, Colombia

Introduction:

Toxoplasma gondii is a parasite with great zoonotic potential. It can infect a broad range of warm-blooded hosts (including livestock) and causes significant losses in the industry. In humans, it has been described as a pathogen in immunosuppressed people, it affects the fetus development in congenital infections, and is associated with various behavioral disorders in healthy people. Humans can acquire T. gondii by consuming undercooked, contaminated meat.

Objective:

To determine T. gondii positivity (currently unknown) in meat for human consumption (i.e., beef, chicken, and pork) in the city of Ibague, Colombia.

Materials and methods:

We used conventional nested PCR and the T. gondii B1 gene sequence as amplification target. We collected samples of meat (N=186) sold in the urban area of Ibagué (62 beef, 62 chicken, and 62 pork samples) and determined the T. gondii positivity percentage for each type of meat.

Results:

The study found an average of 18.8% positivity for all meat samples, pork having the highest percentage (22.5%; 14/62), followed by beef (19.3%; 12/62) and chicken (14.5%; 9/62). The best-amplified products were sequenced by macrogen and aligned with the B1 gene sequences in GenBank, thereby confirming their identity.

Conclusions:

This is the first study of T. gondii prevalence in meat for human consumption carried out in the city of Ibagué and the department of Tolima. All three types of meat sampled represent a risk for local human infection.     

Evaluación de las características operativas de la versión 2.2018 del instrumento de evaluación del malestar emocional de la National Comprehensive Cancer Network en pacientes atendidos en el Instituto Nacional de Cancerología,Bogotá

Introduction:

Cancer patients have significant levels of emotional distress. The National Comprehensive Cancer Network (NCCN) developed the distress management tool to quickly assess significant distress in oncological patients who require intervention. For its use in Colombia, we made its cross-cultural adaptation and validation.

Objective:

To determine the operative characteristics of the distress management tool, version 2.2018, in patients seen at the Instituto Nacional de Cancerología (INC) in Colombia.

Materials and methods:

Counting with the authorization from the NCCN, we translated, made the cross-cultural adaptation, and evaluated the operational characteristics of the tool. We included 343 cancer patients seen at the INC, who filled out the cross-culturally adapted instrument. A diagnostic test study was carried out with a semi-structured interview as a reference.

Results:

The patients had an average age of 49.7 years (SD=15) and the majority were women (67%). The instrument had an area under the ROC curve of 0.81 (95% CI: 0.77 - 0.86); its optimal cut-off point was 3.5 approached to 4 when using integers on the scale; its sensitivity was 0.81 (95% CI: 0.76 - 0.85), and its specificity, 0.69 (95% CI: 0.64 - 0.74). The agreement percentage between the result of the interview and the instrument was 73% (kappa = 0.64; p< 0.001).

Conclusions:

The distress management tool allowed for the detection of moderate to severe distress requiring intervention and management. This instrument was adapted and validated in cancer patients in Colombia keeping the cutoff point at ≥ 4 as in the original version.